HomeMy WebLinkAboutPRE 2019-0013; JAVAHERI ADDITION; Preliminary Review (PRE)-
CITY OF CARLSBAD APPLICATION FORM FO
Would you like to orally present your proposal to your assigned staff planner/engineer? No
Please list the staff members you have previously spoken to regarding this project. If none, please
OWNER NAME (Print): APPLICANT NAME (Print): --f'-Mol-'"+----....,,.,-,~~-~-w--------------MAILING ADDRESS: MA I LING ADDRESS: --+-..;A ....... !,,---1'..+-+-'-.JL.::l...--+--'-~-
C I TY, STATE, ZIP: CITY, STATE, ZIP:
TELEPHONE: TELEPHONE:
EMAIL ADDRESS: EMAIL ADDRESS:
*Owner's signature indicates permission to cond ct
review for a development proposal.
I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE
ABOVE I FORMATION CORRECT TO THE BEST
0 Y NOWLED
I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE
OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE
AND CORRECT TO THE BEST OF MY KNOWLEDGE.
;(. SIGNATURE
APPLICANT'S REPRESENTATIVE (Print):
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE
APPLICANT AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE.
SIGNATURE DATE
DATE
OF REVIEWING THI APPLICATION IT MAY BE NECESSARY FOR MEMBERS OF CITY STAFF TO INSPECT
HE SUBJECT OF THIS APPLICATION. IM/E CONSENT TO ENTRY FOR THIS PURPOSE.
PROPERTY OWNER SIGNATURE
FEE REQUIRED/DATE FEE PAID:
RECEIVED BY:
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Page 3 of 3 Revised 07/17